Pun P, et al. J Am Soc Nephrol. 2019;doi:10.1681/ASN.2018090911.
CPR increases survival but is underused by dialysis staff, efforts vary among clinics
Odds for survival were increased when dialysis staff initiated CPR before the arrival of EMS but the method was not used in approximately 20% of cardiac arrest events, with use in clinics based on specific variables, according to a study published in the Journal of the American Society of Nephrology.
“For cardiac arrests that occurred in outpatient dialysis clinics in North Carolina and metropolitan Atlanta, patients for whom CPR was started by dialysis staff before the arrival of first responders had a three-fold increase in survival,” study researcher Patrick Pun, MD, MHS, associate professor of medicine and nephrology at Duke University School of Medicine and medical director of Durham Veterans Administration Medical Center Dialysis Service, told Healio/Nephrology. “This suggests that immediate bystander CPR is effective for improving survival for dialysis patients just as it is in non-dialysis patients. However, too often, CPR was not provided by dialysis staff.”
To examine the resuscitation efforts of dialysis staff before EMS arrived and the subsequent cardiac arrest outcomes, researchers used data from the Cardiac Arrest Registry to Enhance Survival and the CMS dialysis facility database from which patients who had cardiac arrest within outpatient dialysis clinics between 2010 and 2016 in the southeastern United States were identified. The final cohort consisted of 398 cardiac arrest events (66% presented with a non-shockable initial rhythm) that occurred within 158 clinics.
Using multiple logistic regression models, the outcomes of patients who received dialysis staff-initiated CPR were compared with the outcomes of those who did not receive CPR until the arrival of EMS. The primary outcome was patient survival to hospital discharge with favorable neurological outcome.
Researchers found that dialysis staff initiated CPR in 81.4% of events and applied automated external defibrillators in 52.3%. Patients who received staff-initiated CPR had a three-fold increase in their odds of hospital discharge with favorable neurological status. It was further determined that dialysis staff were more likely to initiate CPR for men (adjusted OR = 1.80) than women, which was possibly due to concern for harming female patients who may have been deemed more fragile, according to the researchers.
Dialysis staff-initiated CPR was also more common when witnessed than when unwitnessed (88% vs. 73%). Finally, researchers observed a greater likelihood of staff-initiated CPR in larger dialysis clinics that had more dialysis stations (aOR = 1.04).
“CPR increases survival in outpatient dialysis clinics and efforts should be made in the dialysis community to improve readiness to provide CPR in clinics,” Pun concluded. “Further research is needed to understand what barriers might exist to providing CPR in clinics, as this study was not able to uncover the reasons why CPR was not initiated by dialysis staff.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.